Workshop Review: Masterclass on the Treatment of Trauma

with Dr. Bessel van der Kolk

St. John of God Conference Centre, Stillorgan, Co. Dublin.
11th May 2015
Reviewed by Sile Mac Neill

The title of Dr. Bessel van der Kolk’s latest book, The body keeps the score: Brain, mind, and body in the healing of trauma, touches most of the corners of his seminar last May, jointly hosted by the Psychological Society of Ireland Division of Clinical Psychology, St. John of God’s services and the HSE.

Dr. van der Kolk’s work on Developmental Trauma Disorder in children has been informing current leading-edge therapeutic approaches with children with complex trauma (including that of Dan Hughes, whose training in Ireland has been enriching our therapeutic pot in recent years). Van der Kolk’s workshop focusing on treatment of adults with PTSD was eagerly anticipated and, although he squeezed it into half a day instead of a full day, his varied and humorous presentation made for a very enjoyable workshop.

He advocates using an eclectic range of therapeutic activities and approaches, including neurofeedback, body-orientated therapies, EMDR (Eye Movement Desensitisation and Reprocessing Therapy) and yoga, rather than promoting the cause of a single therapeutic approach. He reminded us that idealisation of the therapist is usually at the expense of the client. The same can be said for idealisation of a therapy.

He identified three key areas for therapeutic focus with clients who have been traumatised:

Establishing safety
Dealing with traumatic re-enactments
Integration and mastery of the body and mind

Drawing on neuroscience research, he spoke about how the frontal lobes, the seat of executive functioning – planning, anticipating, inhibiting inappropriate actions, empathic understanding – are affected by trauma. Trauma also affects sub-cortical brain areas over which one has no conscious control or recall – parts which control functions such as arousal, sleep, breathing and chemical balance.

He explained that these areas retain imprints of the trauma so that the traumatised person keeps reacting as though his or her life is still in danger. He talked about how these areas of the brain need to be ‘rewired’ in order to recover from the trauma.

He described how attractors in one’s brain determine what one focuses on and that these may be changed following trauma. There is a tendency to repeat the trauma. He showed a video of a man who had been traumatised, coming across a fairly common mother/child altercation in a supermarket. Witnessing this triggered a re-experiencing of the man’s trauma and led to a behavioural outburst, which not only frightened people around him, but also left him with shame and bewilderment.

He highlighted the necessity of helping the client feel safe at a deep physiological level and recommended physical activity, including practices such as yoga, which can regulate the brainstem through breathing, movement and touch.

He highlighted the need to create new realities. He spoke about completing the ‘circuit of competency’ – running versus being trapped. Ideally, when threatened, one runs or performs some other action that ensures one’s safety, escapes and survives. On the other hand, the traumatised person experiences panic, helplessness and lack of power. He showed an example of completing the circuit of competency – a child’s drawing, in which the child placed a trampoline at the foot of the Twin Towers, so that those who jumped out of the building would be saved.

He spoke about disturbing memories being a cause of ongoing traumatic reaction, and the need to come to a realisation that ‘that was then and this is now’.

He said that, although telling secrets can be an important function of talking therapies, there is no absolute need for the therapist to hear the story; the client does not have to be able to tell the story. However, it does seem necessary that the client is aware of the story him- or herself, whether choosing to share it with the therapist or not.

He recommended EMDR as a choice approach for trauma. For example, he explained that the eye movements involved in following a moving finger can bring about a shift in feeling which then, from a position of safety, allows one to recall how one felt during the critical incident. The same technique can also bring a shift in body posture, from the collapsed, slouched to upright, in charge – the way you hold your body determines how you feel.

He spoke about needing to notice oneself from a safe place in order to develop compassion for one’s abused self; and he spoke about the need to build up the ability to reflect – self-compassion and reflection being two critical abilities in therapy.

He asserted that it is not necessary for the person to re-experience the trauma, that what is needed is a quiet frame of mind in which the person can revisit the trauma – a physiological calm, in which the body feels safe and can quietly observe what happened back then. In this, van der Kolk’s approach contrasts with Gestalt and other existential therapies which would, when the client is ready, go on to facilitate re-experiencing the trauma in the here- and-now. This deepens the possibility of completion and transformation of unexpressed emotion, resolution of inner conflict and can lead to reformulation and integration of the experience.

In his own practice, van der Volk uses Richard Schwartz’s (1995) Internal Family Systems Therapy approach, recognising that all parts of the Self have played an important part in one’s survival from trauma.

He talked about a goal of treatment being to enable the client’s capacity to attend to the here-and-now, to notice him- or herself, to experience ‘I am’ body awareness.

Van der Kolk touched on the implications for relationships of behavioural changes following trauma. He spoke about emotional freezing or numbing, isolation from others, and a loss of sense of purpose, of where to go, what to do, following trauma. He recommended Emotional Freedom Techniques (EFT), such as tapping acupressure points, as a way of helping the client who is numb, to feel his or her feelings.

He spoke about the use of activities such as drumming, dancing and martial arts that require one to notice what ‘the other’ is doing, to pick up the rhythmical synchrony of others around one, and to plan one’s own body action accordingly.

These were some of the insights which van der Kolk shared with us. I was left with the certainty that his interest is in understanding the client’s experience – the client is the starting point and the centre of his or her therapeutic work, and is not expected to fit into a predetermined paradigm. However, I was also left wondering whether, without therapeutically supported re-experiencing of the trauma, van der Kolk’s approach goes far enough towards complete integration of the traumatic experience.

Sile Mac Neill is a clinical psychologist and Gestalt psychotherapist. She works in private practice and as an independent practitioner in Blessington, Co. Wicklow.

References:
Schwartz, R. C. (1995). Internal Family Systems Therapy. New York: Guilford Press.

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking Press.